LAUSR

DEAR EDITOR, a 56-year-old Afro-Caribbean woman was started on atezolizumab and bevacizumab for the treatment of metastatic mesothelioma. She developed a florid blistering eruption affecting the torso and limbs. The bullae formed annular plaques with a targetoid appearance (a). She declined a skin biopsy but indirect immunofluorescence (IMF) revealed circulating IgA anti-basement membrane zone antibodies (to a titre of 1 : 800) localized to the roof of human salt-split skin (b). This was consistent with linear IgA bullous dermatosis (LABD). A combination of lymecycline, prednisolone and dapsone led to resolution of the eruption (c). The repeat indirect IMF (antibody titre of 1 : 100) supported the clinical improvement. Drug-induced LABD is typically secondary to vancomycin and has rarely been reported with immunotherapy 1,2